The Break

Content Warning: Suicide, abuse, violence

Morning was quiet in the Emergency Department break room. A respite from the chaos of the department. The TV was on, a nurse absentmindedly changed channels between local sports and a made for TV movie. She had come in for an extra mid shift and had arrived unexpectedly early, traffic was light today. Eyes on the timeclock, she busied herself gathering her supplies. It was almost time to start getting paid, and there was a long list of things she wanted to buy for her next trip. This overtime shift was going to pay off. Now she could hear a commotion outside, nothing new to the ER. When it was time to start her shift, then it would be her problem. A door opened, and a cleaner came in pushing his large cart. Following him was engineering, radioing to an unseen person and examining the door hinges. “Did you make a work order for the door, Miss?” The nurse shrugged. “Umm. It wasn’t me, but the secretary might know more?” Five more minutes till time to clock in. The workman smiled and began examining the door. Everybody worked so hard to ensure things worked well. This place where all of humanity converged was a well run machine. With the door propped open, the commotion outside became louder. And then came the crying. 

All of a sudden, one of the day shift nurses ran into the break room. Breathing heavily, her mouth opened but no words came out for a moment. The mid shift nurse stared at her waiting for some sound. “I-” Was all that came out. “I can’t do this anymore. I can’t. That’s the third kid suicide in like two months. And he didn’t make it. We never got ROSC. He’s just a kid.” Silence filled the break room. The mid shift nurse stood up from the table. The workman put down his tools and stared, shaking his head. The cleaner also stood, head bowed, holding his hands. The three of them made an awkward tableau as the day shift nurse continued to breathe heavily. “I’ve seen some serious trauma; but, but I just can’t see all these kids killing themselves. My own son is his age!” Tears filled her eyes but wouldn’t dare to leave. This nurse had witnessed so many traumatic events in her years in the ER, neither a novice nor part of the old guard, just a part of doing this job. Neglected nursing home patients who were now barely recognizable as people, victims of extreme violence and abuse, addicted patients who would disappear and turn up dead. Nothing special, really. Compartmentalized in her brain and locked away. It was not possible to ever decompress from all of those terrible things, not when leaving work meant rushing home to begin the next shift of parenting. Her kids made her feel immense guilt at working this sometimes grim job. They didn’t deserve to have a mother who was struggling to stay present in the evenings and during bedtime. They had an overall happy life and did not need that to change. This parallel existence, bearing witness to humanity’s worst moments and then attending PTA meetings filled with debates over parking spaces - it made her world feel very confusing.

Running into the break room was the Charge Nurse. He was a tough guy. Rumor had it he had enacted violence on a patient who was attacking him in the midst of a psychotic break. Sometimes that was the only course of action. The Charge Nurse knew from experience that all ideals go out the window when one is under attack. He faced the day shift nurse squarely. “Hey. I think you need a break. You’ve had all the suicides recently. I can deal with the paperwork and police, I want you to go take a break. Go for a walk outside. I mean it. I’ll put somebody else on the trauma team.” Gruff but kind also. And perceptive. Very perceptive of other people’s struggles and why they would continue their self destructive actions. Underneath the sometimes coarse language was a nurse who had empathy for those who could not see beyond their flailing attempts at soothing their pain. But if one was to jump him, that would not be the emotion one would experience.

The day shift nurse squeezed her eyes to prevent a flow of tears. What would going for a walk even do? There was too much work left to do, other patients in her assignment waiting for their needs to be met. Anyway, the boy was dead now. It’s not like she had to switch gears into ICU nursing to take care of him, stabilize him on pressors, set up an A-line, prepare the whole team for taking him to CT while intubated. She didn’t have to do any of that. Just do a basic clean of the body so the police and coroner could do the next part. So really, it was time to move on.

The Charge Nurse looked at her directly. “I mean it. Take. A. Break. I’ll try and set up a debrief with the ER doc and the rest of the team. Ask the medics too next time they’re back. It’s been a really tough month for everyone.” This got through to her. She nodded through pursed lips. She was going to do a small gesture of taking care of herself and step outside in the fresh air. Inside the ER it seemed like time had no meaning, but stepping outside would reorient herself to the present. That’s what she would do.

“Code Three ER. Code Three ER.” The overhead page sounded robotic, even from the break room. The Charge Nurse trusted the triage nurse would have gotten a good ring down from the fire department. He would have to see what rolled in the door. At this time of the day, and in this city, it could be anything. Hot stroke, sudden cardiac arrest, OD. It was like picking from a menu of tragedies. Whose life was going to be changed forever now? He knew it was time to get back to it. There were other maladies all seated in the waiting room, the bread and butter complaints of the ER. He knew better than to let the waiting room get completely out of control. The last thing they needed among this heartbreaking event was another fight in the lobby. Time to go.

The day shift nurse took a drink of water. The mid shift nurse clocked in, swiped her badge and gave her fellow nurse a quiet hug. They were in it together now. Let’s go.